Иридотомии, нагрузочные/провакационные пробы?

[opto_dive]

Каковы показания к лазерной иридотомии в лечении глаукомы? Какими из функциональных проб Вы пользуетесь?

[AmuRRR]

После острого приступа, если не сделали в приступе, и на парном глазу тоже.
Делать профилактическую базальную колобому лазером на основании мелковатой камеры, прикрытого угла, положительных провокац проб было бы смеловато, но тема интересная. Кстати, НЕ везде на парном глазу после приступа делают.

[AmuRRR]

Изменил предыдущий пост, "не" потерялась

[opto_dive]

из Primary angle-closure and angle-closure glaucoma by Svend Vedel Kessing and John Thygesen Kugler Publications/The Hague/The Netherlands 2007.

In an American multi-centre study17 129 patients with PAC risk anatomy were monitored for up to six years without treatment, and during this period only 25 patients (38 eyes) developed manifest PAC, i.e. approx. 20% of the patients at risk. In a recent study from India43 a similar risk of progression was found (22% of eyes with occludable angles in 180 degree or more developed manifest PAC after 5 years).The estimated risk of developing manifest glaucoma in the individual eyes at risk within a period of five years was estimated at 30% (Kaplan-Meier analysis)17.

The provocation test in the form of dark-room test – prone position (ref: Dark-room test – prone position, Diagnostic methods with PAC) was, however, only positive in 24% of the eyes which later developed manifest PAC. Therefore it was concluded that the method cannot generally be recommended as a predicative test for an iridotomy17.

Even though no predicative method with the desired sensitivity with respect to iridotomy indication exists, the conclusion of the study was that preventive laser treatment should be recommended for all patients with a gonioscopically verified risk anatomy17. A similar attitude was clearly expressed in 1996.

This is especially relevant in bilateral PAC, whereas the occurrence of acute PAC in the first eye creates a clear indication for preventive laser treatment of imminent PAC in the other eye since acute PAC episodes will otherwise occur in 50-75% of these eyes within five years.

Contraindications
• Terminal manifest PAC glaucoma (C/D ratio 0.9 and/or tunnel vision) with pupil block groups I and III due to the risk of post-laser increase in pressure
• Extremely flat anterior chamber with iris/cornea contact as is for instance found in nanophthalmos (ref: Pathophysiology and pathogenesis, PAC with pupil block, p. 55). Under such circumstances iridotomy may result in ciliary block or uveal effusion (formerly known as malignant glaucoma). The alternative laser treatment is iridoplasty
• Pronounced corneal oedema
• Anticoagulation therapy and acetylsalicylic acid treatment: The treatment should be interrupted for a few weeks prior to laser application

17. Wilensky JT, Kaufman PL, Frohlichstein D, et al. Follow-up of angle-closure
glaucoma suspects. Am J Ophthalmol 1993;115:338-46.
43. Thomas R, George R, Parikh R et al. Five year risk of progression of primary
angle closure suspects to primary angle closure: a population based study.
Br J Ophthalmol 2003;87:450-454.

Вопрос задал с целью понять и спасибо AmuRRR'у. Про мидриаз (по моему мнению - цикломед?) или пилокарпиновый тест не сказано. (Лазерным лечение не занимаюсь).

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Русский текст на подобную тему [Ссылки доступны только зарегистрированным пользователям ]

[Dr-vasiliY]

При ДСП и пигментной глаукоме.

[Ссылки доступны только зарегистрированным пользователям ]

Пару раз делал, реально работает. Эффект виден моментально.